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Tytuł:
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Ethnic inequities in screening for diabetes in pregnancy in New Zealand-adherence to national guidelines.
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Autorzy:
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Chepulis L; Medical Research Centre, University of Waikato, Hamilton.
Paul R; Medical Research Centre, University of Waikato, Hamilton; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton.
Lewis-Hills E; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton.
Ratnaweera M; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton.
Mclean N; Department of Human Nutrition, University of Otago, Dunedin.
Wolmarans L; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton; Department of Medicine, University of Auckland, Auckland.
Tamatea J; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton; Department of Medicine, University of Auckland, Auckland; Te Kupenga Hauora Māori, University of Auckland, Auckland.
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Źródło:
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The New Zealand medical journal [N Z Med J] 2020 Nov 20; Vol. 133 (1525), pp. 106-113. Date of Electronic Publication: 2020 Nov 20.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 2022- : Auckland : Pasifika Medical Association Group
Original Publication: Wellington : New Zealand Medical Association
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MeSH Terms:
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Diabetes, Gestational/*diagnosis
Glycated Hemoglobin/*analysis
Guideline Adherence/*statistics & numerical data
Healthcare Disparities/*statistics & numerical data
Adult ; Diabetes, Gestational/ethnology ; Female ; Gestational Age ; Glucose Tolerance Test ; Humans ; Mass Screening ; New Zealand/ethnology ; Practice Guidelines as Topic ; Pregnancy ; Prenatal Diagnosis/methods ; Retrospective Studies
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Substance Nomenclature:
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0 (Glycated Hemoglobin A)
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Entry Date(s):
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Date Created: 20201123 Date Completed: 20201208 Latest Revision: 20221207
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Update Code:
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20240105
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PMID:
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33223553
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Aim: The aim of this study was to assess adherence to the 2014 Ministry of Health (MoH) screening guidelines for diabetes in pregnancy (DiP) by Māori and non-Māori in the Waikato region.
Methods: Clinical records were reviewed for women without known diabetes before pregnancy who delivered in hospitals or community birth centres in the Waikato region during June-August 2017. Screening rates for DiP were assessed using HbA1c, glucose challenge and/or glucose tolerance tests.
Results: Of a total of 807 women, 94% received some form of screening for DiP; 527 (65.3%) underwent HbA1c screening at <20 weeks and 267 (33.1%) underwent testing for gestational diabetes at 24-28 weeks' gestation. However, only 213 (26.4%) received all screening as per the MoH guideline. HbA1c testing was the most common screening performed (83.9% of all pregnancies), and three quarters of women had a glucose load screen at some point during pregnancy. In all measures, screening rates were lower in Māori, with only 17.5% (46 of 263 women) receiving both HbA1c and further glucose load screening in the recommended gestation windows (versus 31.6% (171 of 541) for non-Māori; P<0.0005).
Conclusions: Adherence to screening guidelines for DiP was poor with a marked ethnic inequity. Further work is needed to investigate the barriers to care that drive these differences.
Competing Interests: Nil.
